Microscopic root canal treatment

1. An accurate, precise diagnosis

There are various reasons why a tooth may need root canal treatment. The initial condition of the tooth usually has a significant impact on the ultimate success rate of the treatment. The microscope can reveal signs clearly indicating whether a tooth needs to be root canal treated, or whether the inflammation and pain are caused by a lesion that cannot be cured by this kind of intervention. A tooth can have a hairline crack, for example, which is impossible to detect by any other means than with microscopic examination. This way, we can avoid years of complaints and pain going unexplained, which are often caused by tooth cracks.

 

2. Possibility for the successful treatment of teeth with complex anatomical structure

The anatomy of dental roots has been described based on their general characteristics, just like with other organs.
In reality, however, we often find teeth with structure that is quite different from the textbooks. This can include variations in the number of roots, or the root canals located within these.
Most of the teeth we treat have fewer or more root canals than would be expected according to anatomy books.
There can also be variation in the location of the canals. A root canal does not always start at the point we’re looking for it – the inlet of the canal is often hidden in a place that is difficult to find. Root canals can sometimes be surprisingly narrow or wide, or can be extremely curved.
The use of an operating microscope enables us to safely and successfully treat teeth which present complex, irregular anatomy as described above.

 

3. Possibility of retreatment of teeth which have already had a root canal treatment 

We often encounter teeth which have undergone root canal treatment and still cause complaints.
Such problems are usually caused by painful inflammatory processes around the apex of the root. In many cases, patients don’t even have complaints about a previously root canal treated tooth, only to find out they have a chronic inflammation at the end of an apex during a routine check-up appointment. Two options are possible in such cases. Either the tooth has to be removed, or it can be retreated. Considering that persistent inflammation in a tooth that has already been root canal treated is probably due to an unexplored, untreated canal (or partial canal), or a possibly undetected crack, a successful retreatment can only be carried out with proper magnification: that is, with the use of a root canal microscope.
This way, whenever a tooth with a previous root canal causes complaints, our specialists will recommend microscopic root canal treatment. The good news is that the microscopic technique is usually successful in treating such cases.

 

4. Possibility of special therapies

There are many cases which are more complex than a “simple” root canal treatment. Dentists sometimes need to correct errors made during previous root canals, remove instruments that have broken and left in the canals, fill roots which have been “punctured”, or clean and shape channels which have been filed in a wrong direction (having had their anatomical curve straightened) to return them to their original shape. These procedures require a high degree of professional expertise, but they allow us to save even teeth that have been doomed for extraction.

 

5. Possibility to treat teeth injured in an accident

Accidents can happen to children as well as adults, and they sometimes threaten the integrity of teeth. When it comes to root canal treatments, accidents between the ages of 6 and 10 bear the most significance, especially those involving the frontal incisors. This is because the roots of the incisors are often not yet fully developed at this age, and the apices have not yet formed.
These accidents often require extremely precise treatment of the roots of the damaged tooth, often using special, bioactive materials which promote the development of the root, hereby helping to save the damaged tooth. Microscope use is also essential in these treatments.

 

6. Last but not least: a significant advantage of microscopic root canal treatment is removal of less tooth material 

Using a microscope allows dentist to only remove the amount of tooth material strictly needed during root canal treatment. This will improve the stability and longevity of the treated tooth in the long term. For long-term success, it is very important to remove as little tooth material as possible from around the tooth neck during the procedure.

THE PROCESS OF MICROSCOPIC ROOT CANAL TREATMENT

A root canal procedure involves the following steps:

1. During the administration of anesthesia, we first apply a surface numbing agent, basically a fruit-flavored jelly. This is followed by an injection. The anesthetic procedure needed in cases of severe pulp infections often poses a challenge for the dentist. We offer a wide range of special techniques at our Clinic to achieve a completely painless intervention.
2. Before the start, we take a conventional X-ray or a 3D CBCT scan, which allows us to assess the alignment of root canals with maximum accuracy, enabling us to set up the most accurate diagnosis and treatment plan.
3. As a first step of the procedure, we mount a special, rubber isolation sheet called a “cofferdam” on the tooth to be treated, which separates it from the oral cavity. This way, we can avoid the disinfectants or instruments used during the treatment getting into the oral cavity (despite all precautions).
4. During the first part of the treatment we need to measure the length of the root canals with an electric device called an “apex locator”. Using this in conjunction with the microscopic visuals and the CT images, we can determine the canal length to an accuracy of a hundredth of a millimeter. This will influence the success of the treatment significantly.
5. We then continue with the chemical and mechanical cleaning of the root canals using special tools. This phase requires an endo motor which powers the mechanical instruments used for the enlargement of the root canals, as well as highly flexible, state-of-the-art nickel-titanium canal widening needles and an ultrasonic device for activating disinfectants.
6. At the end of the process, the root canals have to be filled. We use state-of-the-art bioceramic root canal sealants for this step. These materials are perfectly accepted by the tissues of the body, and they also assist with the healing of root canal inflammations.